GMS-CDC

1. The proposed Project focuses on HIV prevention and control among high risk populations along the Greater Mekong Subregion (GMS) transport and economic corridors (Northern, Central and East West Economic Corridors) in Lao People's Democratic Republic (PDR) and Viet Nam. The Project aims to mitigate HIV risks associated with improved connectivity resulting in increased mobility and migration. The project will strengthen provincial and district HIV prevention and control responses through improved knowledge of the epidemic, protocol, standards, accessibility and quality of health services (service packages) in the project areas specifically along the Viet Nam—Lao PDR transport and economic corridors and in conjunction with ADB's ongoing investments in the infrastructure and transport sector. Particular attention will be given to migrant populations, mobile and high risk populations along these corridors and cross-border towns. The basic project information is provided in Appendix 1.

2. Mobility, migration and transport connectivity are closely interrelated and are significant factors in the spread of HIV throughout the GMS. The development of transport and economic corridors in the GMS has led to improved physical connectivity and increased mobility and migration. Improved transport networks combined with large infrastructure projects such as the building of railways, ports, power stations, etc, has provided new economic opportunities attracting migrant workers, commercial retailers and entertainment industries to previously remote and rural communities. New patterns of internal and cross-border migration have emerged. Separation from families, boredom, and the lack of alternative entertainment
opportunities, coupled with disposable income, encourage people on the move to engage in high-risk behaviors, such as unprotected sex, and alcohol and drug use. While these developments have brought new economic opportunities they have also created new risks
especially, the spread of HIV. Local markets, ferries, road stops, construction sites, border crossings, ports and other economic hubs become “hot spots” of sexual entertainment and services. Wives of migrant workers and local communities living along the transport corridors, especially women are vulnerable and at risk, as they often lack the skills and knowledge to protect themselves from HIV infection.

3. According to the AIDS Commission for Asia1 a focus on geographic ‘hot spots’ and high disease burden localities must be given priority when expanding coverage of HIV prevention activities. In the GMS, Lao PDR is considered as a low prevalence (0.2%) country but with a steadily growing HIV epidemic2 with particular vulnerability in transport corridors and crossborder areas. Heterosexual transmission accounts for 87% of all new infections among mobile populations, farmers, laborers and women. About 79% of all registered HIV cases in Viet Nam are in the age group of 20-39 years and people living with HIV are getting younger. In Viet Nam the HIV prevalence is 0.53%3 and the virus is primarily driven through unprotected sex. Epidemiological information indicates that the number of if HIV cases among men is as high as 75% meanwhile women carry 25% of the total number of HIV cases5. Although men outnumber women among the newly infected, this does not take into account that heterosexual transmission is on the increase, putting younger women and spouses of migrants at significant risk.

4. The proposed Project will contribute to reducing HIV infections among mobile, migrant and local populations. The Project will target ‘hot spots’, particularly along major transport routes and corridors6, in cross-border areas, and in regions with high seasonal and long-term population mobility. Investments in national preventive HIV services and surveillance in one country will maximize benefits for these services in neighboring countries and at the same time create synergies between health, infrastructure and transport programs7. The Project is in line with Viet Nam’s National Strategy on HIV/AIDS Prevention and Control (2004 – 2010) with a vision to 2020, and the objectives of the new Lao PDR’s National Strategy and Action Plan on HIV/STI (2011 – 2015).

5. ADB's GMS and HIV Strategy8 recognizes that the GMS program and priorities with its focus on connectivity, competitiveness and community clearly intersects with some of the key risk factors and features of the HIV epidemic in the sub-region. Hence, the GMS HIV Strategy articulates that ADB has both an obligation to mitigate the HIV risks associated with transport and other infrastructure and an opportunity, to contribute strategically to the response to HIV and poverty in the sub-region. ADB's Country Strategies and Programs for Lao PDR and Vietnam emphasize the need for continued support to communicable disease control including the containment and prevention of the spread of HIV in transport and economic corridors. A
recent ADB study9 on HIV Transmission in Vietnam-Laos Border Areas recommended options to reinforce access and quality of HIV/STI services. While different countries in GMS present similar contexts, the specific nature of each transition station should be considered in the development of strategies and actions that help reduce vulnerability.
 
Source: ADB